October 11, 2016

Medha Vyavahare pictured on the far right with colleagues

during a field visit in Clarens, South Africa

Truly Understanding Health Systems
Strengthening

Medha Vyavahare (YSPH
’17), GHLI Intern

As
a GHLI intern, I recently traveled to South Africa to learn about the Chronic
Centralized Dispensing and Distribution (CCMDD) Initiative—a national effort to
improve access to medicines for South Africans with chronic diseases.

When
I learned about the necessity of system-wide approaches in global health as a public
health student at Yale the term ‘health systems strengthening’ seemed vague. It
wasn’t until I got to South Africa that I realized the nature of
system change.

Patients
diagnosed with HIV or other chronic diseases face significant challenges
accessing their medications in South Africa. Congested public clinics, long
waiting times, and stock outs are common. Many patients take days off work to
get their medications in crowded clinics—sometimes to find the medicines aren’t
even available.

Project Last Mile—a partnership applying The Coca-Cola Company’s supply-chain
expertise to public health systems across Africa — works with the CCMDD to expand
the availability of medicine across South Africa. Project Last Mile collaborates
with the government and local non-profit organizations to create convenient pick-up-points
for medicines in grocery stores, post offices, and other community locations.

Though
restructuring wasn’t easy, what I saw in South Africa was impactful. I visited public
pharmacies starting to receive shipments of the new, neatly packaged individual
parcels of medicine. Through the use of mapping tools and strategic thinking, more
accessible pick-up points were identified based on patient demand – a very
exciting outcome for the resident pharmacists. There was a pervasive optimism about
the program—one pharmacist remarked that the CCMDD was a transformation of the pharmaceutical industry.

The
program still faces implementation challenges, but I believe that the emerging
health system in South Africa is stronger. The nation’s openness to change
makes me hopeful for meaningful improvement on patients’ abilities to lead
healthier lives.